August 24, 2010

USA: Charles Schrader - Needing connection, not just services

MINNEAPOLIS - ST. PAUL, Minnesota / The Star Tribune / August 24, 2010

Opinion / Commentary

Charles Schrader: Needing connection, not just services

By Charles Schrader
The Medi Van rolled up to Ashton Care Center in Pipestone, dropped its metal lift, and waited for a 98-year-old lady to be wheeled out the front door of the nursing home. The home had recently announced that it had run out of funds, and thus would be discharging all its residents by the end of September.

To passersby, the transaction no doubt appeared routine. To my wife and me, it was devastating. The lady I had come to know as "Grandma," my mother-in-law for 35 years, was not only losing what we had assumed would be her last home. She was losing her hometown, too, and with it her connection to her life as a wife, mother, teacher, pianist, inveterate New York Times crossword puzzle aficionado, friend and volunteer.

As the lift folded into the van, my wife and I wondered: Was this the right decision, moving Clarissa to a care facility close to our suburban Twin Cities home? Did she grasp the significance of the move?

Two days later we got our answer, when Grandma, now safely ensconced in her new home, urged my wife to "...get our money back from the tour," and then inquired, "When are we going home?"

Always the counselor, I inquired, "What would going home mean to you, Grandma?" Clarissa became very still, and then her eyes sparkled, the web of wrinkles crisscrossing her face spreading with joy as she explained, "Why, going back to the classroom -- home, you know."

Yes, Grandma, we do know, and yet we don't. My wife and I were not prepared for the dementia that is slowly gobbling up the mind of this grand old lady. And we really had very little awareness of the leviathan that we are coming to know as "the long term care system."

While the institutions we thought we could rely on -- especially assisted living facilities and nursing homes --are, for the most part, rock solid and staffed by caring professionals, still, there is something missing, much to be desired. When $55,000 a year buys you a 10-by-10 half of a double room, a hospital bed, and a 5-minute wait for a nursing assistant to wheel you into a shared bathroom, happiness is reduced to a concept.

From a lay perspective, the model of care that society provides for its elderly seems as aged as its clients. While professional and well-managed, the long-term-care industry appears to be an assembly line of mechanical efficiency that, due to limited resources, lacks attention to what is most important -- our emotional and spiritual selves.

A good nursing home has excellent physical health care, good food, recreational opportunities, caring staff and clean facilities. But meeting the needs of folks with crumbling bodies and shrinking minds, whose dignity erodes with the months of the calendar, requires more than services. What's needed is a deep connection with others that can lift one out of isolation and despair, into a world of purpose and joy.

An assignment this tough requires more than nursing homes and assisted living apartments. It requires us. All of us, working together, using technology to elevate care but not to replace human contact. A public-private family collaboration that puts aside turf wars about who is going to pay for what, in favor of designing custom models of individual treatment that bring family, friends and neighbors back to the health care table. To deliver care where a client is, or wishes to be, efficiently, with less regulation and bureaucracy.

For instance, rather than federal and state government annually coming up with, say, $20,000 to $30,000 in assistance to meet the needs of a particular aged client, why not help that client's family build a small apartment on their home so they can provide basic care and supports to their loved one themselves -- supported by help from outside professionals as needed?

Why not modestly reimburse the young nursing student next door to attend to the needs of an elderly neighbor --giving baths, preparing meals, or monitoring the administration of medication, without the onerous requirements of a "license" to do so.

The idea is that insurance companies and government could creatively allow family and friends to deliver services to the elderly whenever feasible. Costs would certainly fall as bureaucracy gave way to community support.

There was a time when old age and death were natural parts of everyday life. Family and friends drifted in and out of each others' homes, giving neighbors what they needed -- love and connectedness, and in the process, "services."

My guess is that my baby boom generation will not tolerate long-term health care as it now exists when they need it. Besides, its costs would swamp us.

What better time to start preparing ourselves individually for old age by cultivating our minds and nurturing our relationships, while collectively putting in place support systems -- not institutions -- that give meaning and joy to the elderly.

Grandma, always the teacher, your tutorial has not been lost on your daughter and son-in-law. You want to go home. We get it.

Charles Schrader, Plymouth, is a retired family counselor.

© 2010 Star Tribune.